Types of ABA & How ABA Therapy Works
If you’re learning more about Applied Behavior Analysis (ABA) therapy to support a child with disabilities, you’ll want to know what methods and strategies are available to help your child. We spoke with Faye Carter, PhD, BCBA-D, regional director of ABA services for STAR of CA, and Jennifer Symon, PhD, BCBA-D, a professor in the Division of Special Education at California State University, to get the lowdown.
Types of ABA
There are multiple service options for ABA, and individual therapists may use a single system or multiple systems in combination.
Discrete Trial Training (DTT)
DTT is a structured form of ABA done one-on-one with a therapist and the child. First, the therapist will present the materials to the child (for example, they might say, “point to the blue square”). When the child gives the correct response, they are rewarded with a primary reinforcer, which can be anything from a token to a high-five. If the child gives an incorrect answer, the therapist will often remove the materials and prompt again.
DTT is highly repetitive, and the trial will be run multiple times as predetermined by a behavior analyst to collect accurate data, which can track an individual’s growth. Evidence indicates that DTT is best used with children between two and nine years old. DTT has been shown to have positive effects on a child’s cognitive, academic, social, language, and behavioral skills.
While DTT is still used in ABA programs, other models that prioritize working with children in play-based or natural settings are becoming more popular with behavior analysts.
Early Intensive Behavioral Intervention (EIBI)
EIBI is often administered between twenty and forty hours per week; children younger than five typically receive this highly structured service. While more research needs to be done, EIBI may support children with autism to develop adaptive behavior skills, expressive and receptive language, and academic skills.
Pivotal Response Training (PRT)
PRT is set up in a natural environment and is “child-led,” meaning the child will guide the session. For example, if the goal is for the child to interact with others, a therapist can set up a large trough with bubbles for a group of children to play in. The therapist will not force the child to play with others at the trough, but the child may be enticed to join in if the activity is one they already enjoy.
PRT builds on the interests of the child, which makes it useful for developing play, motivation, self-management, self-initiation, language and communication, and social skills.
PRT is best suited for children between two and sixteen years old. Studies have shown that eighty-five percent of children with autism who started the program before age five were able to develop verbal language skills, which became their primary mode of communication.
Early Start Denver Model (ESDM)
ESDM is a hybrid therapy that promotes both free play and structure as needed. It is typically used for infants and toddlers with autism between the ages of five and twelve months. ESDM therapy primarily focuses on developing social-emotional and language skills and cognitive abilities.
One significant difference between ESDM and other models is that therapists may have multiple goals per activity. For example, in DTT, a child may be presented with blue and red triangles and asked to point to the blue ones to teach them to differentiate between colors. In ESDM, the child may be simultaneously learning about color, what a triangle is, and to repeat the words “triangle” or “blue.”
Note that there is a difference of opinion as to whether ESDM is a type of ABA or a closely related alternative.
Verbal Behavior Intervention (VBI)
VBI is used to promote language skills in children with disabilities. According to Carter, neurotypical children will usually develop what behavior analysts call “tacts” before other language skills. When a child uses a tact, they are labeling something. For example, a toddler might point at their toy and say, “truck.”
To help develop language skills, ABA therapists will often begin teaching children to ask for something because it can be immediately reinforced with the object the child requested. For example, a child might approximate the word “ball” by saying “ba,” which is reinforced by the therapist giving them the ball. Over time, the child will be encouraged to say more of the word or a complete sentence. As Carter puts it, “You adjust the goal as the child progresses to make it more challenging.”
Natural Environment Training (NET)
NET is used wherever the child is and follows their daily routine. This is advantageous because it gives the therapist an inside look into what skills the child will need daily, and it provides the child with the benefit of learning new skills on the go.
NET is more inclusive than other types of ABA, as it allows children with disabilities to remain in their general education classroom rather than being pulled out for therapy. It also gives children more control over the activities chosen for sessions.
Strategies and tools used in ABA
Behavior analysts use the ABCs of behavior to analyze and collect data related to behavior. The data includes what happens before, during, and after a behavior occurs and is used to create a behavior intervention plan (BIP).
A BIP will serve as a roadmap for how behavior will be learned, reduced, or modified. It includes information such as:
your child’s goal,
the target behavior to be learned, reduced, or modified, and
what interventions will be used to support your child in meeting their goals.
Functional Behavior Assessments
Before a BIP is created, behavior analysts will typically administer a Functional Behavior Assessment (FBA), which will help determine the “why” of a child’s behavior. An FBA can be conducted if your child needs a change in placement or 1:1 aide, or if the IEP team determines that it is necessary.
Ideally, an FBA will be administered by a Board Certified Behavior Analyst (BCBA), but it can also be done by a Board Certified Assistant Behavior Analyst (BCaBA) under the supervision of a BCBA or BCBA-D. Registered Behavior Technicians (RBTs) can assist in data collections for assessments but cannot conduct them independently.
Positive vs. negative reinforcement
A reinforcer is anything that serves to increase a behavior, regardless of whether it is traditionally thought of as a “reward.” For example, giving a child a piece of candy after cleaning their room can be considered a reinforcer only if the child cleans their room more often in the future. It is not a reinforcer if the behavior stays the same or decreases.
A positive reinforcer will give something to the child that they want, like extra screen time or a toy to play with, while a negative reinforcer will take something away that they don’t want, such as reducing the number of chores they need to complete. In ABA, the word “negative” just implies that a stimulus is being removed, and “positive” indicates something is being added. There is a common misconception that a negative reinforcer is equivalent to a punishment; however, that is not necessarily the case. The goal for any reinforcer is to increase the desired behavior. Therefore, giving a child something they want or removing something unpleasant from their environment can both achieve that goal and reinforce desired behavior.
On the other hand, a punishment is anything that will decrease a behavior. A positive punishment is introducing something to the environment or giving something to the child to reduce unwanted behavior. For example, a parent might increase chores for a child who is making a mess. A negative punishment occurs when something is removed. For example, a teacher may reduce outside time for students who are distracting their peers.
Punishments in ABA can often look like we expect, but not always. For example, in behavior modification, it is a punishment if a child is yelling to get a reaction and the teacher either remains neutral or ignores the behavior, and the behavior decreases as a result.
It is important to remember that a child’s goals need to be personally motivating; for parents, that means making sure the ABA therapist they choose takes the time to tailor the approach to their child. What reinforcer will best encourage your child to engage in activities during ABA sessions?
Prompts and prompt fading
Therapists use prompts to indicate to the child that it is time to complete a task, such as a verbal cue or gesture. When a program is new, prompting will typically occur each time. However, over time, a prompt will be “faded,” which can be done by decreasing the magnitude or amount of prompting over time. For example, suppose a therapist uses a physical prompt by guiding a child’s hand to the correct response. They can fade the prompt by starting to hold just their forearm, then just their elbow, and then only touching their shoulder. This reduces the amount of help they give over time while increasing the amount the child does independently.
Task analysis will break down a difficult task for a child into a series of smaller, more manageable steps. For example, cooking a meal can be broken down as follows:
Gather your cooking materials (bowls, utensils, pots, and pans).
Measure the ingredients into their proper containers.
Turn on the stove.
Wait for the food to cook.
Stir the food.
Turn off the stove.
Strain or place the food onto a plate.
Put all cooking materials into the sink or dishwasher.
Each step will be treated as an individual task for the child to learn. How often they receive reinforcement during the sequence will depend on the individual but can vary. For example, one child might get a sticker after each step while another must finish the entire task chain to receive recognition.
Task analysis can be presented by describing in detail how each step should be completed or by modeling how it is done. In some cases, a therapist or a child’s peer may record themselves completing each step to create a video model for a child to follow.
While a task chain is being taught, a therapist may model some steps to show the child how they should be completed. For example, a therapist may complete or prompt each step except for the last one, which the child will do independently. Or, the child may complete the first step, followed by the therapist prompting or modeling the rest.
Task analysis is a versatile strategy that can be used to teach children of all ages important skills; for example, therapists can use task chains to teach preschool-aged children to resolve minor social conflicts, elementary school students to get themselves ready for school in the morning, or middle schoolers to solve algebraic equations.
Picture Exchange Communication System (PECS)
PECS is used to teach communication skills with the use of image cards. Therapists can teach children to use picture cards to ask for something they want. Over time, children are taught to create sentences about themselves and their environment.
According to Symon, because engaging with peers is an important goal for many children receiving ABA services, therapists can facilitate interactions by giving the child or their peers opportunities to engage directly with each other. For example, they could ask a child to give another student a sticker, pass out or collect materials in class, or be the door monitor.
If you’re considering ABA therapy for your child, you may have a lot of questions about where to find a provider and how to pay for it. Be sure to check out our ABA 101 article for answers to these questions along with tips for interviewing potential providers to make sure you find the right fit.